Effect of social deprivation on blood pressure monitoring and control in England: a survey of data from the quality and outcomes framework.
OBJECTIVE
To determine levels of blood pressure monitoring and control in primary care and to determine the effect of social deprivation on these levels.


METHODS
Retrospective longitudinal survey, 2005 to 2007.


METHODS
General practices in England.


METHODS
Data obtained from 8515 practices (99.3% of all practices) in year 1, 8264 (98.3%) in year 2, and 8192 (97.8%) in year 3.


METHODS
Blood pressure indicators and chronic disease prevalence estimates contained within the UK quality and outcomes framework; social deprivation scores for each practice, ethnicity data obtained from the 2001 national census; general practice characteristics.


RESULTS
In 2005, 82.3% of adults (n=52.8m) had an up to date blood pressure recording; by 2007, this proportion had risen to 88.3% (n=53.2m). Initially, there was a 1.7% gap between mean blood pressure recording levels in practices located in the least deprived fifth of communities compared with the most deprived fifth, but, three years later, this gap had narrowed to 0.2%. Achievement of target blood pressure levels in 2005 for practices located in the least deprived communities ranged from 71.0% (95% CI 70.4% to 71.6%) for diabetes to 85.1% (84.7% to 85.6%) for coronary heart disease; practices in the most deprived communities achieved 68.9% (68.4% to 69.5%) and 81.8 % (81.3% to 82.3%) respectively. Three years later, target achievement in the least deprived practices had risen to 78.6% (78.1% to 79.1%) and 89.4% (89.1% to 89.7%) respectively. Target achievement in the most deprived practices rose similarly, to 79.2% (78.8% to 79.6%) and 88.4% (88.2% to 88.7%) respectively. Similar changes were observed for the achievement of blood pressure targets in hypertension, cerebrovascular disease, and chronic kidney disease.


CONCLUSIONS
Since the reporting of performance indicators for primary care and the incorporation of pay for performance in 2004, blood pressure monitoring and control have improved substantially. Improvements in achievement have been accompanied by the near disappearance of the achievement gap between least and most deprived areas.
Ashworth
Mark
M
King's College London, Department of General Practice and Primary Care, Division of Health and Social Care Research, London. mark.ashworth@kcl.ac.uk
Medina
Jibby
J
Morgan
Myfanwy
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001795:Blood Pressure Determination / Q000592:standards* / Q000706:statistics & numerical data; D002908:Chronic Disease; D004739:England; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D012959:Socioeconomic Factors